Prevalence and Pattern of Oral and Maxillofacial Pathology in Al-Qassim Region, Saudi Arabia.

Objective: The purpose of this study is to determine the prevalence and features of oral and maxillofacial lesions found in the residents of Al-Qassim region, Saudi Arabia. Methods: A retrospective study was conducted at King Fahad Specialist Hospital, Buraidah, Qassim, KSA. The data for all biopsied oral and maxillofacial lesions were retrieved from January 2014 until August 2022. All patients' data including age, gender, location of the lesion, and histopathologic diagnosis were reviewed and analyzed using IBM SPSS version 23 and Microsoft Excel. Results: A total of 381 oral pathology biopsies for individuals aged 18 and above were included in a descriptive analysis. One hundred ninety five (51.18%) of patients were male, and 186 (48.82%) were female. The site most commonly biopsied was the oral mucosa (26%). The diagnosis was categorized according to the histopathological diagnosis into 13 categories including all pathological lesions in the oral and maxillofacial area. The frequently biopsied category was soft tissue pathological lesion category (26%), second to that is the odontogenic cyst category (22%), and third is the immunological-mediated lesion category (13%). The sub-diagnosis that was mostly observed was radicular cyst, lichen planus, and focal fibrous hyperplasia with the percentages of 13.6%, 10.8%, and 9.4%, respectively. Conclusion: The findings provide important information about the oral and maxillofacial pathology in Al-Qassim region, Saudi Arabia. This study found that biopsied oral lesions were more prevalent in males and in patients in the fourth decade of life. The oral mucosa was the most biopsied site, and the majority of the biopsies were soft tissue pathological lesions and radicular cyst was the most frequent diagnosis. Knowledge of such demographic and clinical features of oral and maxillofacial pathology cases helps in prediction of disease incidence and subsequent proper patient care in the region.

Gingival Proliferative Verrucous Leukoplakia and Cancer: A Systematic Review With Meta-Analysis.

OBJECTIVE: Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder. Forms that affect only one tissue are poorly studied, especially the exclusively gingival PVL (gPVL), which may have a more increased malignant transformation potential. The aim of the present study was to characterise the gPVL and its risk of malignant transformation to better raise awareness of this specific disorder. MATERIALS AND METHODS: The systematic review was performed on PubMed, Scopus, Web of Science and Google Scholar. Only articles reporting primary studies, case reports and case series were included. The meta-analysis was performed for the cancer prevalence, proportion of smokers, age and sex ratio, recurrences of gPVL and mortality. RESULTS: A total of 1298 studies were assessed for eligibility by reading titles and abstracts. Fourteen original articles were included with a total of 58 patients. The malignant transformation rate of gPVL was 47.75%. The mortality was 5.84%. The mean follow-up duration before malignant transformation was 3 years. CONCLUSION: gPVL seems to have a faster malignant transformation rate than the other forms of PVL. Finding anatomo-pathological or genetic markers could be a line of research to predict gPVL malignant transformation and improve its diagnosis and treatment.

Exploring the need for surgical face masks in operating room: a comprehensive literature review.

Surgical face masks (SFM) are pivotal in preventing surgical site infections (SSI) in the operating room (OR). However, there are currently no specific recommendations for their most effective use. SFM effectiveness is influenced by factors such as material, fit, and duration of use, sparking ongoing debates about their benefits and risks in surgery. SFMs act as a protective barrier, but their ability to filter out harmful compounds is questioned. They can also impact communication and create a false sense of security. Nevertheless, SFMs aid in infection prevention and provide psychological comfort. Clear guidelines are needed to ensure their appropriate use in the OR. This paper offers a historical overview of surgical masks, emphasizing their role in infection prevention. It explores SFM effectiveness for both the surgical team and patients during surgery and considers their future in surgical settings. As we navigate the evolving landscape of SFMs, clear and concise guidelines are imperative to ensure their judicious and effective use in the OR. This paper serves as an essential resource for understanding the historical significance, contemporary efficacy, and prospective trajectory of SFMs in surgical practice.

Treatment strategy for cervical lymph node metastases from early-stage tongue and floor of the mouth squamous cell carcinoma using tumour budding and depth of invasion as predictors.

OBJECTIVES: This study aimed to determine whether elective neck dissection can help improve outcomes in early-stage tongue and floor squamous cell carcinoma (SCC) by statistically analysing the relationship between information obtained from biopsy specimens and the incidence and prognosis of cervical lymph node metastasis (CLM). MATERIALS AND METHODS: Biopsy specimens of 103 patients diagnosed with early cT1-T2 cancer of the tongue and floor of the mouth were included. RESULTS: Multivariate analysis showed that the three parameters significantly correlated with CLM, and univariate analyses showed that budding score (BS) ≥ 5 and pathological depth of invasion (pDOI) ≥ 5 mm were independent risk factors for CLM. There were significant differences in the 5-year cumulative disease-specific survival between the BS < 5 and BS ≥ 5 groups, the pDOI < 5 mm and pDOI ≥ 5 mm groups, and the positive and negative budding and depth of invasion (BD) score groups. CONCLUSION: In early-stage tongue and floor of the mouth cancers with maximum tumour diameter ≤ 20 mm, it may be necessary to treat occult CLM during initial surgery based on the following preoperative criteria: pDOI ≥ 5 mm or BS ≥ 5 in biopsy specimens and DOI ≥ 8 mm on imaging. The BD model exhibited the highest specificity and proved helpful for CLM prediction. CLINICAL RELEVANCE: pDOI ≥ 5 mm and BS ≥ 5 were independent predictors of CLM and prognosis in early-stage tongue and floor of the mouth cancers with a maximum tumour diameter of 20 mm.

The impact of different timing of mouth opening exercises on trismus in postoperative radiotherapy patients with oral cancer.

OBJECTIVE: To compare the effects of starting mouth opening exercises at two different times on trismus in postoperative radiotherapy patients with oral cancer. METHODS: Through a prospective randomized controlled trial, purposive sampling was used to select 76 patients undergoing postoperative radiotherapy for oral cancer from March 2023 to January 2024 at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Patients were randomly divided into an experimental group (n = 38) and a control group (n = 38) using a random number table at a ratio of 1:1. The experimental group began mouth opening exercises in the second week after surgery (before radiotherapy), while the control group began in the fourth week after surgery (at the start of radiotherapy). The primary outcome measure was maximum interincisal opening (MIO). Secondary outcome measures included pain visual analog scale (VAS) scores and quality of life scores (UW-QOL), assessed at baseline, the second week post-surgery (before radiotherapy), the fourth week post-surgery (at the start of radiotherapy), the ninth week post-surgery (end of radiotherapy), and the twelfth week post-surgery (three weeks after the end of radiotherapy). RESULTS: A total of 72 patients completed all assessments, with 36 in each group, resulting in an overall sample attrition rate of 5.26 % (less than 15 %). There were no statistically significant differences in general demographic and clinical characteristics between the two groups. Repeated measures ANOVA showed significant differences in MIO, VAS, and UW-QOL scores between groups, over time, and in group-time interactions (P < 0.001). From the fourth week post-surgery (at the start of radiotherapy), the experimental group had significantly higher MIO (P < 0.001), significantly lower VAS scores (P < 0.001), and significantly higher UW-QOL scores (P < 0.001) compared to the control group. These differences persisted at subsequent assessment points. CONCLUSION: Initiating mouth opening exercises in the second week post-surgery (before radiotherapy) can significantly improve mouth opening, reduce pain, and enhance the quality of life in postoperative radiotherapy patients with oral cancer. This provides important evidence for clinical practice, although further research is needed to verify the long-term effects.

Evaluation of Efficacy of Aqua Titan Patch in Postoperative Sequelae After Lower Third Molar Surgery: A Prospective Study.

Objective: To evaluate the efficacy of aqua titan patch in postoperative sequelae after mandibular third molar surgery. Material and Methods: A total of 20 patients were selected and divided into two groups, Group A was evaluated by using Aqua titan patch with oral antibiotics and anti-inflammatory analgesics while Group B was only provided with antibiotics and anti-inflammatory analgesics. Results: There were total 20 subjects, with 4 males and 16 females. Pain was evaluated after surgical removal, where significant reduction was observed on 5 and 7th postoperative day in study group with p value 0.004 and 0.013, respectively. Reduction in swelling was observed to be statistically highly significant (p values = 0.000) in study group on 5 and 7th postoperative days. Beneficial results were obtained in study group where mouth opening was statistically significant with p value 0.002 on 5th and 0.049 on 7th postoperative day. For postoperative neurosensory deficit, mean values were constant and difference was found to be statistically insignificant with p value 0.13. Conclusion: Postoperative local application of aqua titan patch in study group provided beneficial effects in terms of reduction in pain, swelling and maximum mouth opening as compared to the control group.

Evaluating the reproducibility and validity of maximal mouth opening measurement techniques.

OBJECTIVES: A limitation of the maximal mouth opening (MMO) is a frequent complication of oral (cancer) surgery. The measurement between the right central incisors is considered the golden standard for assessing MMO, although it has been noted to overestimate MMO in edentulous patients. This study aims to evaluate the reproducibility and validity of four MMO techniques and to determine the extent to which they are dependent on the remaining dentition. MATERIALS AND METHODS: Four methods for capturing the MMO were recorded in consecutive patients with mixed dentition. The degree of agreement between the different measurement methods was compared using Bland-Altman plots. To investigate the reproducibility of each method, intersession, interobserver and intraobserver reliability were calculated for measurements performed by two clinicians across two sessions. Two subgroups were created based on dentition: (A) cases missing at least one right central incisor, and (B) patients with both right central incisors present. RESULTS: All but one intraclass correlation coefficient (ICC) demonstrated excellent reproducibility (ICC > 0.9). The highest ICC values were found for the intraoral MMO(iMMO) and corrected intraoral MMO(ciMMO) method. A significant relationship between the MMO in both subgroups was identified only for the intraoral Range of Motion (iROM) method (p=.010*). CONCLUSION: The findings suggest that the current golden standard for measuring MMO does not adequately account for the absence of the right central incisor(s). Two of the proposed methods, which include corrections for missing incisors, should be incorporated into future clinical trials on MMO.

Platelet-rich fibrin in the management of oral mucosal lesions: a scoping review.

OBJECTIVES: Oral mucosal lesions are prevalent and often cause pain, thus impacting patients' quality of life. Platelet-rich fibrin (PRF) has emerged as a promising autologous biomaterial for wound healing, yet comprehensive evidence regarding its efficacy in treating oral mucosal lesions is limited. This study aims to update the current evidence on the effectiveness of PRF in treating various types of oral mucosal lesions. MATERIALS AND METHODS: We conducted a literature search in PubMed, Scopus, Embase, and Web of Science databases until April 2024. The search included studies that investigated the use of PRF in treating oral mucosal lesions. Twelve studies met the inclusion criteria, comprising three case reports, three randomized controlled trials, two animal studies, three split-mouth trials, and one retrospective study. We performed data extraction according to a predefined form. RESULTS: PRF was applied in two forms-membranes and injectable gels-to treat a range of oral mucosal lesions, including ulcerative, red and white, pigmented, and potentially malignant or malignant lesions. Compared to control groups or conventional treatments, PRF generally demonstrated superior outcomes regarding faster healing, lesion size reduction, symptom relief, and lower recurrence rates. Histological and molecular analyses from some studies also indicated PRF's regenerative and anti-inflammatory effects. CONCLUSION: PRF shows promise as an effective and safe alternative to current treatments for oral mucosal lesions due to its autologous nature, ease of preparation, and wound-healing capabilities. However, further research is needed to standardize PRF preparation protocols and confirm its long-term efficacy across different lesion types.

Enhancing cancer care through addressing a neglected pillar: a narrative review on quality of life in Pakistani patients.

The current narrative review was planned to evaluate the quality of life of Pakistani cancer patients. Using relevant questionnaires and comparing global data over the last 2 decades, the review planned to explore artificial intelligence's role in cancer care, and to develop strategies for better outcomes. The review yielded poor results and exposed huge and neglected gaps in the overall approach towards the management of cancer patients based on different tumour types and categories. A few experimental interventions demonstrated promising results and echoed the need for further clinical and non-clinical experimentation for negating poor quality of life outcomes. Unsurprisingly, not a single study in the literature analysed, revealed a positive quality of life. A multi-pronged approach, therefore, must be brainstormed and safely implemented through experimentation of artificial intelligence and active coordination among healthcare bodies, finance/economic boards and welfare organisations that are active in countries like Pakistan to uplift the neglected quality of life domain among cancer patients, especially breast and oral cancers that have the highest incidences worldwide.

Effect of turmeric and triphala in the treatment of oral submucous fibrosis among Indians.

Oral Submucous Fibrosis (OSMF) is a potentially malignant precancerous lesion. Various treatment modalities are tried to cure it including herbal medicaments. Therefore, it is of interest to determine whether using 1 gramme of triphala and 1 gramme of turmeric combined in a glycerine solution would be clinically effective in treating oral submucous fibrosis (OSMF). The study comprised thirty-six participants in the 18-50 age range who had no systemic problems. The medications prescribed for the patients were to be applied three to four times a day. Before and after therapy, blood samples were taken in order to check for any systemic outcomes of the drugs. Both before and after therapy, there were recordings of the burning feeling and mouth opening. For 4 months, patients were checked on a monthly basis after that. A statistical analysis was performed for the variations in the mouth opening and the changes in the burning sensation on the visual analogue scale (VAS). There was a statistically significant improvement in the mouth opening and burning sensation. Turmeric and triphala provide a natural product combination that is both safe and effective for treating OSMF symptoms.

Protein characterization of an Indonesian isolate of foot and mouth disease virus inactivated with formaldehyde and binary ethylenimine.

Background and Aim: Foot-and-mouth disease (FMD) is a highly contagious viral disease of cloven-footed animals. It is a major threat to livestock production worldwide, causing significant economic losses. Inactivation of FMD virus (FMDV) is crucial for vaccine development and control of outbreaks. However, traditional inactivation methods can sometimes damage the viral protein, affecting vaccine efficacy. Therefore, finding new inactivating agents that effectively inactivate the virus while preserving the integrity of its proteins is an important research area. This study investigated the optimal materials (0.04% formaldehyde, 0.001 M binary ethylenimine [BEI], or a combination) for inactivating and preserving the specific molecular weight of Serotype O FMDV protein. Materials and Methods: This study used serotype O FMDV isolated from several areas of East Java. The virus was inoculated into baby hamster kidney-21 cells, and the titer was calculated using the TCID50 Assay. The virus was inactivated using 0.04% formaldehyde, 0.001 M BEI, or a combination of 0.04% formaldehyde and 0.001 M BEI. Inactive viral proteins were characterized using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and western blotting. Results: Serotype O FMDV can be inactivated using 0.04% formaldehyde while preserving specific FMDV proteins, specifically VP0 and VP3 with a molecular weight (MW) of 36 kDa and VP3 with a MW of 24 kDa. Serotype O FMDV can be inactivated by 0.001 M BEI while preserving specific FMDV proteins, specifically VP0 with a MW of 35 kDa, VP3 with a MW of 28 kDa, and VP1 with a MW of 23 kDa. FMDV serotype O can be inactivated using a combination of 0.04% formaldehyde and 0.001 M BEI while preserving specific FMDV proteins, specifically VP0 and VP3 with a MW of 36 kDa and VP3 with a MW of 24 kDa. Conclusion: This study found that 0.04% formaldehyde, alone or in combination with 0.001 M BEI, was effective for inactivating and preserving the specific molecular weight of Serotype O FMDV protein. The limitation of this study was the inactivations of the virus have not yet been tested for their potency on experimental animals. Further research is warranted to investigate the inactivation kinetics of these materials, including their potency on experimental animals. Additionally, a comparison of the inactivation rates between 0.04% formaldehyde alone and the combination with BEI would help to determine the optimal inactivation agent for future applications.

Enhanced Effects of ISA 207 Adjuvant via Intradermal Route in Foot-and-Mouth Disease Vaccine for Pigs.

In South Korea, a mandatory nation-wide foot-and-mouth disease (FMD) vaccination policy is in place. However, a major side effect of the current method of intramuscular (IM) administration of oil-adjuvanted FMD vaccines is the formation of granulomas in the muscles of pigs. To address this issue, we assessed the possible application of intradermal (ID) vaccination. Initially, we compared the serological immune response in specific pathogen-free pigs inoculated with FMD vaccines formulated with eight different adjuvants, administered twice at the neck site using a syringe with a needle via the ID route. Among the formulations (water-in-oil-in-water (W/O/W), oil-in-water (O/W), and polymer nanomaterials), ISA 207 of W/O/W was the most effective in inducing immunogenicity followed by ISA 201 of W/O/W. ISA 207 was further tested in formulations of different antigen doses (12 or 1.2 µg) delivered via both IM and ID routes. All four treatments successfully protected the pigs against FMD virus challenges. To assess the feasibility of the field application of the vaccines with ISA 207, we conducted ID vaccination of conventional pigs using a needle-free device, resulting in the detection of significant levels of neutralizing antibodies. ISA 207 was shown to be superior to ISA 201 in inducing immunogenicity via the ID route. In conclusion, ISA 207 could be a suitable adjuvant for ID vaccination in terms of vaccine efficacy for FMD, allowing for alternate use of ID vaccination and subsequent reduction in the incidences of granuloma formation in the field.

Long-Term Immunogenicity Study of an Aluminum Phosphate-Adjuvanted Inactivated Enterovirus A71 Vaccine in Children: An Extension to a Phase 2 Study.

Enterovirus A71 (EV-A71) causes hand, foot, and mouth disease in infants and children with potential for fatal complications such as encephalitis and acute flaccid myelitis. This study examined the long-term immunity conferred by EV71vac, an inactivated EV-A71 vaccine adjuvanted with aluminum phosphate, in children from the age of 2 months to <6 years, for up to 5 years after the first immunization. A total of 227 participants between 2 months and <6 years of age who had previously received either EV71vac or placebo in the phase two clinical study were enrolled. Subjects were divided into age groups: 2 years to <6 years (Group 2b), 6 months to <2 years (Group 2c), and 2 months to <6 months (Group 2d). At Year 5, the neutralizing antibody titers against the B4 subgenotype remained high at 621.38 to 978.20, 841.40 to 1159.93, and 477.71 to 745.07 for Groups 2b, 2c, and 2d, respectively. Cross-neutralizing titers at Year 5 remained high against B5 and C4a subgenotypes, respectively. No long-term safety issues were reported. Our study provides novel insights into the long-term immunity conferred by EV71vac in children aged from two months to six years, particularly in those who received EV71vac between two and six months of age.

Diet and Oral Squamous Cell Carcinoma: A Scoping Review.

Oral squamous cell carcinoma (OSCC) is the sixth most common type of cancer globally. While smoking is a key risk factor, rising cases in non-smokers highlight the need to explore other factors like diet. This scoping review aims to deepen the evidence on the relationship between OSCC and diet, following PRISMA-ScR guidelines, and was registered on Open Science Framework. Searches were performed in four electronic databases: MEDLINE, Embase, Web of Science, and Lilacs, without date or language restrictions. Studies were evaluated, extracted, and compiled in a narrative table. Seventeen studies with 10,954 patients were analyzed. Most patients were male (74.63%), aged 18-89 (average 50.62). Studies were mainly from high (82%) and medium (17%) Human Development Index (HDI) countries. Dietary surveys included a Food Frequency Questionnaire (FFQ) (58.8%), interviews/questionnaires (17.6%), and an FFQ with a photographic atlas (5.9%). Certain foods in excess like fruits, vegetables, and tea were inversely associated with OSCC, while salty meats, dairy, coffee, sausages, and fried and spicy foods were positively associated. Due to the heterogeneity of the tools used to obtain food frequency data, the results should be interpreted cautiously. New standardized studies and randomized trials are essential to advance understanding and control confounding factors in this field.

Oral cancer preventive behaviors in rural women: application of the theory planned behavior.

Background: Oral cancer is becoming a primary concern for non-communicable illnesses and global health care initiatives. Low-income people, people with disabilities, the elderly, residents of detached and rural regions, and people belonging to minority groups bear a greater burden of oral diseases. The purpose of this research is to identify rural women's oral cancer prevention activities using the theory of planned behavior (TPB). Methods: The current research is a cross-sectional analysis of 700 female hookah users who were referred to rural health facilities in Fasa and Shiraz, Fars, Iran in 2019-2020. The participants were selected by random sampling method. The TPB questionnaire and a demographic information questionnaires were the data gathering instruments used in this study to assess oral cancer prevention practices among participants. Data were analyzed by SPSS 22 using frequency, mean, and standard deviation as descriptive statistics, and Pearson correlation coefficients and linear regression as inferential statistics at a significance level of P < 0.05. The Kolmogorov-Smirnov test was used to determine whether the data were normal. Results: The average age of the participants was 44.54 ± 8.72 years, and the average age at which they started hookah was 23.8 ± 28.68 years. The average history of hookah use was 15.8 ± 6.65 years, and the average size of the household in the test group was 4.73 ± 1.16. The average scores of the constructs of the TPB and oral cancer prevention behaviors were average or at a low level, while nicotine addiction was relatively high. The constructs of knowledge, attitude, subjective norms, and behavioral intention are significantly correlated with oral cancer prevention behaviors in hookah-user women. There was a significant inverse relationship between nicotine dependence and oral cancer prevention behaviors, and there was a strong link between perceived behavioral control and behavioral intention (P < 0.05). Conclusion: Based on the results of this study, the average scores of the structures of the TPB and oral cancer prevention behaviors were average or at a low level among rural hookah-user women, which indicates the necessity of an educational program based on this theory for rural women to adopt and maintain oral cancer prevention behaviors.

Dosimetric benefits of customised mouth-bite for head neck cancer patients undergoing modern proton therapy - An audit.

Background and aims: Proton therapy (PRT) for Head Neck Cancer (HNC), in view of the Bragg peak, spares critical structures like oral mucosa better than IMRT. In PRT, mouth-bites, besides immobilising and separating mucosal surfaces, may also negate the end-of-range effect. We retrospectively analysed the details and dosimetric impact of mouth-bites in PRT for HNC. Materials and methods: The data of consecutive HNC patients treated with IMPT from May 2020 to August 2022 were studied retrospectively. Details of the mouth-bite used, compliance and resultant mucosal separation were noted. Further analysis, restricted to previously unirradiated patients, comprised volumetric dosimetric data pertaining to the mouth-bite and distal mucosal surfaces. High LET zones, corresponding to 6-12 keV/micron, for mouth-bite doses above 30 Gy, were recalculated from existing plans. Results: A mouth-bite was used in 69 of 80 consecutively treated patients, ranging from 8 to 42 mm in thickness, and 12 to 52 mm in the resultant mucosal sparing. In 42 patients in whom the mouth-bite V 32 Gy was > 0, median Dmean, absolute V32, V39, V50 and V60 GyE (Gray Equivalent) of the mouth bite was 35.65 GyE (Range: 2.65 - 60 GyE), 10 cc (Range: 0.1 - 32 cc), 7.6 cc (Range: 0.1 - 30.8 cc), 5.7 cc (Range: 0.2 - 29.2 cc) and 1.45 cc (Range: 0.2 - 18.1 cc) respectively, all significantly more than the spared adjacent mucosal surface. In absence of a mouth-bite, the spared mucosa would have at least partially received the high dose received by the mouth-bite. High LET zones were noted in 12 of 48 mouth-bites. Conclusion: In PRT for HNC, mouth-bites play a vital role in improving the sparing of mucosa outside the target.

Parameters to assess the necessity of adjuvant therapy for early-stage oral squamous cell carcinoma.

OBJECTIVE: One-third of head and neck squamous cell carcinomas are early-stage oral cavity squamous cell carcinomas (OCSCC). Despite a high curative rate, 20% of early-stage OCSCC patients do not achieve long-term survival. This study evaluates the role of adjuvant therapy (ADJ) in delaying disease progression and prolonging survival. METHODS: This single-institute retrospective cohort study enrolled 481 early-stage OCSCC patients, 16% (78/481) of whom received ADJ. It was reported according to the STROBE guidelines. Cox proportional hazards regression and Kaplan-Meier survival curves were employed to identify suitable candidates for ADJ. RESULTS: The 5-year locoregional recurrence-free survival (LR-RFS) and overall survival rates were 73.2% and 84.9%, respectively. Positive margins and advanced depth of invasion (DOI) were independent predictors of LR-RFS. For patients with positive margins, adjuvant chemoradiotherapy (CRT) was superior to adjuvant radiotherapy alone in improving LR-RFS (hazard ratios for adjuvant CRT vs. none, 0.042; adjuvant radiotherapy alone vs. none, 0.702). Excluding positive margins, advanced DOI was the most critical factor in assessing the need for ADJ. Positive margins and advanced DOI were more appropriate criteria than EORTC 22931/RTOG 9501 for evaluating adjuvant CRT. CONCLUSIONS: Adjuvant CRT was indicated for patients with positive margins and advanced DOI to improve survival outcomes.

Utility of Digastric Muscle Flap in Reconstruction of Floor of Mouth Defects.

In the era of free flaps, we propose a simple yet effective local flap, the digastric muscle flap, to reconstruct floor of the mouth defects and to repair an orocervical fistula that is created during excision of tongue and/or floor of the mouth malignancies. The digastric muscle flap was used in 15 patients who were diagnosed with oral squamous cell carcinoma of the tongue and/or floor of the mouth. Partial glossectomy was performed in 4 cases, hemiglossectomy in 4 cases, and wide local excision in 7 cases. Adjuvant radiation was given in 9 patients. In all cases, the neck was addressed followed by the tumour excision. The floor of the mouth defect created while excising the tumour was repaired with the digastric muscle flap. Post-operative healing was satisfactory in all the cases. No flap failure was seen even in radiated cases. Patients were discharged by the 5th-7th day. Oral feeds were started by the 10th day. Patients were followed for 3 months to 5 years. The digastric muscle flap is an ideal flap for reconstructing small- to medium-sized floor of the mouth defects. The flap can withstand radiation. Due to the high success rate, we propose utilisation of this flap in reconstructing floor of the mouth defects and to seal orocervical fistulas.

Treatment of a lip defect in a patient with choreaacanthocytosis using a combination of surgical and adjuvant onabotulinumtoxinA therapy: a case report.

Chorea-acanthocytosis (ChAc) is an extremely rare neurodegenerative disorder characterized by movement disorders and acanthocytosis. Orofacial dyskinesia is a distinct symptom of this disorder that can lead to lip injuries and feeding difficulties. This paper reports the first case of a patient with ChAc presenting with a lip defect, who was managed with surgical and adjuvant onabotulinumtoxinA (BTX-A) therapy. A 43-year-old woman diagnosed with ChAc was referred to our clinic because of a 5× 5 mm lip defect resulting from orofacial dyskinesia. Wedge resection of the scar tissue was carried out, followed by reconstruction by suturing. Postoperatively, BTX-A injections were administered to ameliorate dyskinesia. Thirty units of BTX-A were injected into each masseter muscle, and 40 units were injected into the orbicularis oris muscle. At 1, 2, and 4 weeks after the injections, assessments were performed using the Abnormal Involuntary Movement Scale, and the patient's impression of change was assessed using the Global Rating of Change Scale. Subsequent adjuvant BTX-A treatment yielded subjective and objective improvements in orofacial dyskinesia. In conclusion, lip reconstruction and adjuvant BTX-A injections were effective in treating lip defects associated with orofacial dyskinesia in patients with ChAc, which highlights the need for a multimodal treatment approach.